Comparison between the Methods for Fixation of Greater Trochanteric Fragment in Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture

ABSTRACT

Purpose: To evaluate clinical and roentgenographic outcomes after bipolar hemiarthroplasty utilizing three different greater trochanteric fragment fixation methods for intertrochanteric fracture repair. Materials and Methods: Forty-six hips (Boyd-Griffin type II 44, type IV 2) that had undergone greater trochanteric fragment fixation through bipolar hemiarthroplasty were evaluated at a minimum of 1 year following surgery. The fixation groups were 1) figure of 8 wiring (18 cases), 2) cerclage wiring (23 cases), and 3) tension band wiring (11 cases). The roentgenographic results were evaluated in terms of fragment migration and wire breakage. The functional results were evaluated according to the hip rating scale of Merle d'Aubigne. Results: The rate of fragment migration was 22.2% in group 1, 52.2% in group 2, and 9.1% in group 3, and there was a statistically significant difference among the groups (p=0.022). The rate of wire breakage was 27.8% in group 1, 13.0% in group 2, and 9.1% in group 3, but there was no statistically significant difference among the groups. According to the Merle d'Aubigne scale, 78.6% of the repairs in group 1, 82.4% of the repairs in group 2, and 88.9% of the repairs in group 3 were rated as excellent, very good, or good. Conclusion: The tension band wiring method is more useful than the figure of 8 and cerclage wiring methods for fixing the greater trochanteric fragment during bipolar hemiarthroplasty.